Diagnosis, staging and control of hypertension – the paradigm shift to systolic blood pressure

Abstract

Hypertension is an important medical and public health issue affecting one billion people worldwide and accounting for approximately 7.1 million deaths per year. The relative importance of systolic blood pressure (SBP) and diastolic blood pressure (DBP) has been a subject of much debate since the introduction of sphygmomanometry into clinical practice. Earlier reports and guidelines had chosen DBP as the primary parameter for diagnosing, staging and control of hypertension. However, studies have shown that SBP is an important cardiovascular and renal risk factor than DBP particularly in the middle aged and elderly individuals. Also, grading and eligibility for drug therapy were better assessed using SBP than DBP. In addition, poor SBP control is largely responsible for the unacceptably low rates of overall blood pressure control. Thus, evidence abounds to show that SBP is more important than DBP in the diagnosis, staging (classification), risk stratification and management of hypertension. This informed the paradigm shift to SBP as the primary parameter for diagnosing, staging and control of hypertension.

Nigerian Medical Practitioner Vol. 50(1) 2006: 3-8